射频消融治疗室上性心动过速118例报告

THE RADIOFREQUENCY CATHETER ABLATION OF SUPRAVENTRI- CULAR TACHYCARDIA IN 118 CONSECUTIVE PATIENTS

目的研究射频消融术治疗室上性心动过速的疗效及方法学。方法对１１８例室上性心动过速患者行射频消融术，旁路在心室最早激动点（ＥＶＡ）或心房最早激动点（ＥＡＡ）消融，双径路则采用慢径改良或快径消融。结果１１８例患者中，房室旁路６７例（６９条旁路），双径路４８例，双径合并左侧旁路３例，总体成功率９４．９％；旁路消融无复发，慢径改良消融中２例复发，但二次消融成功；并发症为股动脉栓塞２例、股静脉栓塞和永久性Ⅲ度房室传导阻滞各１例。结论①ＥＡＡ、ＥＶＡ、标测是旁路消融成功的关键；②后间隔旁路消融时Ｘ线影像定位很重要；③慢径改良消融成功率极高，但即使在远离ＨＩＳ束区消融，亦能造成Ⅲ度房室传导阻滞；故放电以“点射”

Objective To study the method and efficacy of radiofrequency catheter ablation (RFCA) for supraventricular tachycardia (SVT).Methods 118 patients with SVT were treated by RFCA. The accessory pathway (AP) ablation was performed where the earliest ventricular action (EVA) or the earliest atrial action (EAA) was mapped out. For double A-V node pathway (DP), the ablation site was slow or fast pathway (SP or FP).Results A success rate of 94.9% was obtained in the series of 118 patients (67 cases of AP, 48 DP and 3 combined AP and DP). Tachycardia recurred in 2 cases of DP, which was cured by reablation. The complications occurred were femoral artery occlusion (2 cases), femoral vein occlusion (1 case) and persistant Ⅲ-AVB (1 case).Conclusions ①The mapping of EVA and EAA is the key to the success of AP ablation.②X-ray location plays an important role in the ablation of postseptal AP. ③Although the successful rate of SP modification of A-V node is very high, Ⅲ-AVB is likely to occur even when the site of ablation is some distance to the His bundle. Hence it is advised to administer interrupted “firing” with the power increased step by step.